Skip to main content
SpringerLink
Log in

Syndesmosis Injuries: Surgical Indications, Techniques, and Outcomes

  • Chapter
  • First Online:
Ligamentous Injuries of the Foot and Ankle

  • 1133 Accesses

Abstract

Syndesmosis injuries are increasingly common in sports. Recent developments in treatment indications, surgical techniques, and return-to-play protocols compel the orthopedic and sports medicine clinician to pay close attention to surgical technologies and their outcomes. The focus of this chapter is on treatment indications, surgical techniques, return to sport, and treatment outcomes for ligamentous syndesmosis injuries in the athlete. Flexible fixation devices are the preferred construct for athletes although screws remain an option where preferred. There is a trend toward more rapid rehabilitation and return to sport following surgical repair of the syndesmosis, as well as a trend toward more careful tracking of outcomes.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 84.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 109.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 109.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Lubberts B, D'Hooghe P, Bengtsson H, DiGiovanni CW, Calder J, Ekstrand J. Epidemiology and return to play following isolated syndesmotic injuries of the ankle: a prospective cohort study of 3677 male professional footballers in the UEFA elite Club injury study. Br J Sports Med. 2019;53(15):959–64.

    Article  Google Scholar 

  2. Hunt KJ, George E, Harris AH, Dragoo JL. Epidemiology of syndesmosis injuries in intercollegiate football: incidence and risk factors from National Collegiate Athletic Association injury surveillance system data from 2004-2005 to 2008-2009. Clin J Sport Med. 2013;23(4):278–82.

    Article  Google Scholar 

  3. Waterman BR, Belmont PJ Jr, Cameron KL, Svoboda SJ, Alitz CJ, Owens BD. Risk factors for syndesmotic and medial ankle sprain: role of sex, sport, and level of competition. Am J Sports Med. 2011;39(5):992–8.

    Article  Google Scholar 

  4. Hogg-Cornejo VHK, Bartolomei J, Rullkoetter PJ, Myers C, Shelburne KB. Normal kinematics of the syndesmosis and ankle mortise during dynamic movements. Foot Ankle Orthop. 2020;5(3):2473011420933007. https://doi.org/10.1177/2473011420933007.

    Article  PubMed  PubMed Central  Google Scholar 

  5. van Dijk CN, Longo UG, Loppini M, et al. Classification and diagnosis of acute isolated syndesmotic injuries: ESSKA-AFAS consensus and guidelines. Knee Surg Sports Traumatol Arthrosc. 2016;24(4):1200–16.

    Article  Google Scholar 

  6. Tornetta P 3rd, Spoo JE, Reynolds FA, Lee C. Overtightening of the ankle syndesmosis: is it really possible? J Bone Joint Surg Am. 2001;83(4):489–92.

    Article  Google Scholar 

  7. Park YH, Ahn JH, Choi GW, Kim HJ. Comparison of clamp reduction and manual reduction of syndesmosis in rotational ankle fractures: a prospective randomized trial. J Foot Ankle Surg. 2018;57(1):19–22.

    Article  Google Scholar 

  8. Schlatterer D, Ramirez M, Deshpande C. Eliminating syndesmotic reduction variability: a novel elastic wrap reduction tool. Orthopedic Trauma Association Meeting 2018; Scientific Poster #17; 2018.

    Google Scholar 

  9. Schlatterer D, Despande C, Morgenstein A. A novel elastic wrap for syndesmotic reduction with post-operative CT scan analysis. Foot Ankle Orthop. 2019;4:2473011419S2473010037.

    Article  Google Scholar 

  10. Edwards GS Jr, DeLee JC. Ankle diastasis without fracture. Foot Ankle. 1984;4(6):305–12.

    Article  Google Scholar 

  11. McKeon KE, Wright RW, Johnson JE, McCormick JJ, Klein SE. Vascular anatomy of the tibiofibular syndesmosis. J Bone Joint Surg Am. 2012;94(10):931–8.

    Article  Google Scholar 

  12. Zhan Y, Yan X, Xia R, Cheng T, Luo C. Anterior-inferior tibiofibular ligament anatomical repair and augmentation versus trans-syndesmosis screw fixation for the syndesmotic instability in external-rotation type ankle fracture with posterior malleolus involvement: a prospective and comparative study. Injury. 2016;47(7):1574–80.

    Article  Google Scholar 

  13. Akoh CC, Phisitkul P. Anatomic ligament repairs of syndesmotic injuries. Orthop Clin North Am. 2019;50(3):401–14.

    Article  Google Scholar 

  14. Sagi HC, Shah AR, Sanders RW. The functional consequence of syndesmotic joint malreduction at a minimum 2-year follow-up. J Orthop Trauma. 2012;26(7):439–43.

    Article  Google Scholar 

  15. Naqvi GA, Shafqat A, Awan N. Tightrope fixation of ankle syndesmosis injuries: clinical outcome, complications and technique modification. Injury. 2012;43(6):838–42.

    Article  Google Scholar 

  16. Weening B, Bhandari M. Predictors of functional outcome following transsyndesmotic screw fixation of ankle fractures. J Orthop Trauma. 2005;19(2):102–8.

    Article  Google Scholar 

  17. Boszczyk A, Kwapisz S, Krummel M, Grass R, Rammelt S. Correlation of incisura anatomy with syndesmotic malreduction. Foot Ankle Int. 2018;39(3):369–75.

    Article  Google Scholar 

  18. Phisitkul P, Ebinger T, Goetz J, Vaseenon T, Marsh JL. Forceps reduction of the syndesmosis in rotational ankle fractures: a cadaveric study. J Bone Joint Surg Am. 2012;94(24):2256–61.

    Article  Google Scholar 

  19. Darwish HH, Glisson RR, DeOrio JK. Compression screw fixation of the syndesmosis. Foot Ankle Int. 2012;33(10):893–9.

    Article  Google Scholar 

  20. Michelson JD. Ankle fractures resulting from rotational injuries. J Am Acad Orthop Surg. 2003;11(6):403–12.

    Article  Google Scholar 

  21. Miller AN, Carroll EA, Parker RJ, Boraiah S, Helfet DL, Lorich DG. Direct visualization for syndesmotic stabilization of ankle fractures. Foot Ankle Int. 2009;30(5):419–26.

    Article  Google Scholar 

  22. Summers HD, Sinclair MK, Stover MD. A reliable method for intraoperative evaluation of syndesmotic reduction. J Orthop Trauma. 2013;27(4):196–200.

    Article  Google Scholar 

  23. Wake J, Martin KD. Syndesmosis injury from diagnosis to repair: physical examination, diagnosis, and arthroscopic-assisted reduction. J Am Acad Orthop Surg. 2020;28(13):517–27.

    Article  Google Scholar 

  24. Mendelsohn ES, Hoshino CM, Harris TG, Zinar DM. The effect of obesity on early failure after operative syndesmosis injuries. J Orthop Trauma. 2013;27(4):201–6.

    Article  Google Scholar 

  25. Thompson MC, Gesink DS. Biomechanical comparison of syndesmosis fixation with 3.5- and 4.5-millimeter stainless steel screws. Foot Ankle Int. 2000;21(9):736–41.

    Article  CAS  Google Scholar 

  26. Moore JA Jr, Shank JR, Morgan SJ, Smith WR. Syndesmosis fixation: a comparison of three and four cortices of screw fixation without hardware removal. Foot Ankle Int. 2006;27(8):567–72.

    Article  Google Scholar 

  27. Forsythe K, Freedman KB, Stover MD, Patwardhan AG. Comparison of a novel FiberWire-button construct versus metallic screw fixation in a syndesmotic injury model. Foot Ankle Int. 2008;29(1):49–54.

    Article  Google Scholar 

  28. Klitzman R, Zhao H, Zhang LQ, Strohmeyer G, Vora A. Suture-button versus screw fixation of the syndesmosis: a biomechanical analysis. Foot Ankle Int. 2010;31(1):69–75.

    Article  Google Scholar 

  29. Qamar F, Kadakia A, Venkateswaran B. An anatomical way of treating ankle syndesmotic injuries. J Foot Ankle Surg. 2011;50(6):762–5.

    Article  Google Scholar 

  30. Degroot H, Al-Omari AA, El Ghazaly SA. Outcomes of suture button repair of the distal tibiofibular syndesmosis. Foot Ankle Int. 2011;32(3):250–6.

    Article  Google Scholar 

  31. Willmott HJ, Singh B, David LA. Outcome and complications of treatment of ankle diastasis with tightrope fixation. Injury. 2009;40(11):1204–6.

    Article  CAS  Google Scholar 

  32. Naqvi GA, Cunningham P, Lynch B, Galvin R, Awan N. Fixation of ankle syndesmotic injuries: comparison of tightrope fixation and syndesmotic screw fixation for accuracy of syndesmotic reduction. Am J Sports Med. 2012;40(12):2828–35.

    Article  Google Scholar 

  33. Shimozono Y, Hurley ET, Myerson CL, Murawski CD, Kennedy JG. Suture button versus syndesmotic screw for syndesmosis injuries: a meta-analysis of randomized controlled trials. Am J Sports Med. 2019;47(11):2764–71.

    Article  Google Scholar 

  34. Schepers T. To retain or remove the syndesmotic screw: a review of literature. Arch Orthop Trauma Surg. 2011;131(7):879–83.

    Article  CAS  Google Scholar 

  35. Storey P, Gadd RJ, Blundell C, Davies MB. Complications of suture button ankle syndesmosis stabilization with modifications of surgical technique. Foot Ankle Int. 2012;33(9):717–21.

    Article  Google Scholar 

  36. Hsu AR, Lareau CR, Anderson RB. Repair of acute superficial deltoid complex avulsion during ankle fracture fixation in National Football League players. Foot Ankle Int. 2015;36(11):1272–8.

    Article  Google Scholar 

  37. D'Hooghe P, Grassi A, Alkhelaifi K, et al. Return to play after surgery for isolated unstable syndesmotic ankle injuries (west point grade IIB and III) in 110 male professional football players: a retrospective cohort study. Br J Sports Med. 2020;54(19):1168–73.

    Article  Google Scholar 

  38. D'Hooghe P, Grassi A, Alkhelaifi K, et al. Return to play after surgery for isolated unstable syndesmotic ankle injuries (west point grade IIB and III) in 110 male professional football players: a retrospective cohort study. Br J Sports Med. 2020;54(19):1168–73. https://doi.org/10.1136/bjsports-2018-100298.

    Article  PubMed  Google Scholar 

  39. Dellenger R. Tua Tagovailoa’s ankle injury pins Alabama in familiar territory. https://www.si.com/college/2019/10/20/tua-tagovailoa-ankle-injury-alabama-lsu-outlook. Published 2019. Accessed 7 Dec 2020.

  40. Hunt KJ, Bartolomei J, Challa S, Tuffiash M, Annunziato A, ISAKOS LAF. Significant variations in surgical construct and return to sport protocols with syndesmotic injuries: an ISAKOS global perspective. J ISAKOS. 2022;7(1):13–8.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, University of Colorado School of Medicine, Aurora, CO, USA

    Kenneth J. Hunt & Stephen Blake Wallace

Authors
  1. Kenneth J. Hunt
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Stephen Blake Wallace
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Kenneth J. Hunt .

Editor information

Editors and Affiliations

  1. Department of Orthopedic Surgery, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar

    Pieter D’Hooghe

  2. Department of Orthopedic Surgery, University of Colorado School of Medicine, Aurora, CO, USA

    Kenneth J. Hunt

  3. Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, MO, USA

    Jeremy J. McCormick

Rights and permissions

Reprints and permissions

Copyright information

© 2022 The Author(s), under exclusive license to Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Hunt, K.J., Wallace, S.B. (2022). Syndesmosis Injuries: Surgical Indications, Techniques, and Outcomes. In: D’Hooghe, P., Hunt, K.J., McCormick, J.J. (eds) Ligamentous Injuries of the Foot and Ankle. Springer, Cham. https://doi.org/10.1007/978-3-031-08682-3_14

Download citation

  • DOI: https://doi.org/10.1007/978-3-031-08682-3_14

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-031-08681-6

  • Online ISBN: 978-3-031-08682-3

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation